Dr. Paul Casale '82 is the new head of Weill Cornell Medicine's accountable care organization.
For the new executive director of the accountable care organization(ACO) of Weill Cornell Medicine, NewYork-Presbyterian, and Columbia University Medical Center, assuming the leadership of NewYork Quality Care is a homecoming of sorts. Interventional cardiologist Dr. Paul Casale '82, not only earned his medical degree at Weill Cornell Medicine, but he completed his internal medicine residency at NewYork-Presbyterian/Weill Cornell Medical Center before going on to a fellowship in cardiology at Mass General. Dr. Casale, who also holds a master's in public health from Harvard, comes to the post from Lancaster General Health/Penn Medicine, where he served as chief of the Division of Cardiology and medical director of quality. A national leader in the development of high-quality population health programs, Dr. Casale has more than three decades of experience in the field at the local, state and national levels. Founded in January 2015, NewYork Quality Care comprises 4,000 physicians and serves some 30,000 Medicare beneficiaries.
Could you explain in a nutshell what an accountable care organization is?
An ACO is a group of physicians, often coordinating with a health system, who take responsibility for providing high-quality care for a population of patients. Implementation of ACOs has been a major initiative of the Centers for Medicare & Medicaid Services as it moves away from fee-for-service to a value-based payment system.
Why are ACOs important?
The rise in the cost of healthcare in the United States, and the Medicare program in particular, continues to be a significant contributor to the national deficit. There is agreement that these rising costs are unsustainable, and the ACO is one of the building blocks in the movement toward a value- based payment system. In that arrangement, physicians are aligned with the health system in looking for ways to improve quality, enhance the coordination of care and eliminate duplication of services.
Why do you think it's vital for Weill Cornell Medicine to participate in an ACO?
ACOs have been established across the United States in community-based health systems as well as large academic health organizations. Our ACO, NewYork Quality Care, is a combination of three entities — Weill Cornell Medicine, Columbia and NewYork-Presbyterian. These three institutions are world leaders in providing healthcare, and to be successful in a value-based payment system, we need to work together to achieve the "triple aim" as described by the Institute for Healthcare Improvement: improving the patient experience, improving the health of populations and reducing per-capita cost of care.
In general, how do ACOs benefit patients?
ACOs benefit patients by enhancing the coordination of care, improving quality of care and reducing costs. For physicians to understand how well they are caring for a group of patients, it requires access to accurate and timely data on the quality and cost of care. Improving the ability of electronic health records to track performance measures and enhancing the information exchange among physicians and health systems will benefit patients.
Could you give an example of an outcome that illustrates how an ACO can help a patient?
When a patient suffers a heart attack, he or she enters the hospital and receives the needed care. A stent is placed in the blocked artery and the patient is dis- charged within a few days with new medications. Addressing behaviors that might contribute to him or her coming back with further heart problems is an important aspect of the follow-up care. For example, many patients with heart disease have diabetes or smoke. In our current system, patients receive counseling about diabetes management or smoking cessation during an office visit, but in an ACO a patient may receive additional care through an enhanced care management system, which often includes social workers, pharmacists and community health workers. Pharmacists are an important member of the care team, because patients are often on a long list of new medications after a heart attack and are confused about why or how they should take them. In addition to the traditional home health nursing visits, in an ACO, a pharmacist or a community health worker could conduct a home visit to be sure the patient understands the correct medication dosing and the importance of the dosing schedule. It's extending the care a patient had in the hospital at the time of the acute event in order to manage the illness and enhance health.
How do you think Weill Cornell Medicine will benefit as an institution from participating in an ACO?
Putting patients first is always the priority in healthcare, and an ACO emphasizes a patient-centric approach. WCM's participation in an ACO will lead to better care coordination for our patients. WCM has a world-renowned Department of Healthcare Policy and Research, which has already written many important papers on the transition to a value-based payment system in the United States. As we develop the ACO, there will be more opportunities for research using our own data to understand the impact of these payment models on patient care. In addition, Weill Cornell Medicine is educating the physicians of the future. This change in payment will be part of that future — not only in practice, but also as our alumni become leaders in their field.
How is NewYork Quality Care distinct from other ACOs?
Among the unique features of our ACO is the involvement of two world-class medical schools and one of the top 10 hospitals in the country. There are challenges inherent in an ACO in an academic health system. One is that there are many medical students, residents and fellows who help provide care — so there are more people who need to be educated and involved in the process of implementing new initiatives for the ACO. On the other hand, there are exceptionally bright physicians, nurses and others who can be creative and innovative in helping advance ideas for care transformation in the ACO, as theory often doesn't translate into practice.
Are there ways in which having been a medical student and a resident at this institution will inform your approach to the job?
Interestingly, there are still quite a few people who were here when I was a stu- dent and a resident, and having those personal relationships is always helpful when leading change. My dedication to the success of the ACO is enhanced by the fondness and appreciation I have for the medical school and the hospital.
What do you find especially gratifying about practicing medicine in the context of an ACO?
As an interventional cardiologist, by the time my patients come to the cardiac catheterization laboratory, they may not have been managing their health very well — their diabetes, high blood pressure, cholesterol, smoking and other life- style choices. After decades of practice, I see many patients come back to the cath lab for additional procedures. Although we can provide exceptional care with the advances in medical technology, there is much more to do in preventive care. For me, that's a growing passion — to develop tools to enhance prevention and health promotion. As we keep people healthy, we dramatically improve their quality of life.
— Beth Saulnier
This story first appeared in Weill Cornell Medicine, Vol. 15, No.2.